Local governments are responsible for the management of social medical insurance for urban and rural residents in China. Under the background of fiscal decentralization between the central government and local governments, the strengthening of supervision on medical insurance funds by local governments leads to a reduction in the expenditure of the medical insurance fund, which contributes to its sustainability. By employing the provincial level panel data during 2004–2014, we used a fixed effect model and a spatial autoregression model to investigate whether fiscal decentralization has had a negative influence on the expenditure of China’s new rural cooperative medical system (NCMS) fund. We found that fiscal decentralization has had a significant influence over its per capita expenditure. Our results also indicate that higher fiscal decentralization leads to higher financial aid in the NCMS provided by local governments. Additionally, the expenditure of the NCMS and the local financial aid are influenced by nearby governments. Our results suggest that appropriate fiscal decentralization, which helps to maintain the sustainability of social medical insurance funds, should be encouraged.
From 2013 to 2017, progress has been made by implementing the Air Pollution Prevention and Control Action Plan. Under the background of the 3 Year Action Plan to Fight Air Pollution (2018–2020), the pollution status of PM2.5, a typical air pollutant, has been the focus of continuous attention. The spatiotemporal specificity of PM2.5 pollution in the Chinese urban atmospheric environment from 2018 to 2020 can be summarized to help conclude and evaluate the phased results of the battle against air pollution, and further, contemplate the governance measures during the period of the 14th Five-Year Plan (2021–2025). Based on PM2.5 data from 2018 to 2020 and taking 366 cities across China as research objects, this study found that PM2.5 pollution has improved year by year from 2018 to 2020, and that the heavily polluted areas were southwest Xinjiang and North China. The number of cities with a PM2.5 concentration in the range of 25–35 μg/m3 increased from 34 in 2018 to 86 in 2019 and 99 in 2020. Moreover, the spatial variation of the PM2.5 gravity center was not significant. Concretely, PM2.5 pollution in 2018 was more serious in the first and fourth quarters, and the shift of the pollution's gravity center from the first quarter to the fourth quarter was small. Global autocorrelation indicated that the space was positively correlated and had strong spatial aggregation. Local Moran's I and Local Geti's G were applied to identify hotspots with a high degree of aggregation. Integrating national population density, hotspots were classified into four areas: the Beijing–Tianjin–Hebei region, the Fenwei Plain, the Yangtze River Delta, and the surrounding areas were selected as the key hotspots for further geographic weighted regression analysis in 2018. The influence degree of each factor on the average annual PM2.5 concentration declined in the following order: (1) the proportion of secondary industry in the GDP, (2) the ownership of civilian vehicles, (3) the annual grain planting area, (4) the annual average population, (5) the urban construction land area, (6) the green space area, and (7) the per capita GDP. Finally, combined with the spatiotemporal distribution of PM2.5, specific suggestions were provided for the classified key hotspots (Areas A, B, and C), to provide preliminary ideas and countermeasures for PM2.5 control in deep-water areas in the 14th Five-Year Plan.
Background The security of medical insurance fund is very important to health equity. In China, the expenditure of medical insurance fund has increased sharply year after year, and the balance of local medical insurance fund is difficult to sustain. To realize the equitable distribution of the medical insurance burden, the central government has to continuously increase transfer payments, which causes regional unfairness in the distribution of central financial resources. This paper explores the influence of central transfer payments on the balance of medical insurance fund, influential mechanisms, and the strategic behavior of local governments. Methods First, we constructed a dynamic game model between central government and local governments and analyzed the mechanism of central transfer payments affecting the balance of local medical insurance fund. Then, based on the provincial panel data of 28 provincial administrative regions in China from 2004 to 2014, an empirical test was made. The spatial regression model was constructed, and the transfer payments obtained by neighboring provinces in the previous year were taken as instrumental variables. Results Central transfer payments led to strategic behaviors by local governments that resulted in increased local health insurance fund expenditures and lower balance rates. Moreover, the central transfer payments demonstrated “path dependence”. Central transfer payments had a significant negative influence on the local NCMS fund balance rate. The local government subsidy and per capita GDP had a significant positive impact on the local NCMS fund balance rate. The obtained transfer payments of local governments had a significant space correlation. This study based on NCMS data remains valid. Conclusions Central transfer payments induced the strategic behavior of local governments, which neglected to supervise the expenditure of medical insurance fund, reducing the efficiency of medical insurance fund management and use. The financial resources of medical insurance fund are unevenly distributed among provinces. Measures such as strengthening the supervision ability and initiatives of local governments, refining the central transfer payment mechanism, promoting the economic growth of western regions, and increasing rates for individual contributions appropriately can ensure that the medical insurance fund are used well and distributed equitably.
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